Trends and Outcomes with Kidney Failure from Antineoplastic Treatments and Urinary Tract Cancer in France

Abstract

Background and objectives: Cancer survival is improving along with an increase in the potential for adverse kidney effects from antineoplastic treatments or nephrectomy. We sought to describe recent trends in the incidence of kidney failure related to antineoplastic treatments and urinary tract cancers and evaluate patient survival and kidney transplantation access.

Design, setting, participants, & measurements: We used the French Renal Epidemiology and Information Network registry to identify patients with kidney failure related to antineoplastic treatments or urinary tract cancer from 2003 to 2015. We identified 287 and 1157 cases with nephrotoxin- and urinary tract cancer-related kidney failure, respectively. The main study outcomes were death and kidney transplantation. After matching cases to two to ten controls (n=11,678) with other kidney failure causes for age, sex, year of dialysis initiation, and diabetes status, we estimated subdistribution hazard ratios (SHR) of each outcome separately for patients with and without active malignancy.

Results: The mean age- and sex-adjusted incidence of nephrotoxin-related kidney failure was 0.43 (95% CI, 0.38 to 0.49) per million inhabitants and 1.80 (95% CI, 1.68 to 1.90) for urinary tract cancer-related kidney failure; they increased significantly by 5% and 2% annually, respectively, during 2006-2015. Compared with matched controls, age-, sex-, and comorbidity-adjusted SHRs for mortality in patients with nephrotoxin-related kidney failure were 4.2 (95% CI, 3.2 to 5.5) and 1.4 (95% CI, 1.0 to 2.0) for those with and without active malignancy, respectively; for those with urinary tract cancer, SHRs were 2.0 (95% CI, 1.7 to 2.2) and 1.1 (95% CI, 0.9 to 1.2). The corresponding SHRs for transplant wait-listing were 0.19 (95% CI, 0.11 to 0.32) and 0.62 (95% CI, 0.43 to 0.88) for nephrotoxin-related kidney failure cases and 0.28 (95% CI, 0.21 to 0.37) and 0.47 (95% CI, 0.36 to 0.60) for urinary tract cancer cases. Once on the waiting list, access to transplantation did not differ significantly between cases and controls.

Conclusions: Cancer-related kidney failure is slowly but steadily increasing. Mortality does not appear to be increased among patients without active malignancy at dialysis start, but their access to kidney transplant remains limited.

Keywords: France; antineoplastic agents; cancer; comorbidity; confidence intervals; diabetes mellitus; end-stage kidney disease; humans; incidence; information services; kidney transplantation; nephrectomy; nephrotoxicity; radiation; registries; renal dialysis; renal insufficiency; survival; urinary tract cancer; urologic neoplasms; waiting lists.

Graphical abstract

Figure 1.

Study flow chart.

Figure 2.

Standardized incidence rates per million inhabitants (pmi) of cancer-related ESKD increased between 2006 and 2015. AAPC, average annual percent change; 95% CI, 95% confidence interval.

Figure 3.

Cumulative incidence of all-cause mortality and wait-listing for kidney transplantation. (A) Mortality on dialysis among patients with nephrotoxin-related ESKD. (B) Mortality on dialysis among patients with urinary tract cancer–related ESKD. (C) Kidney transplant wait-listing among patients with nephrotoxin-related ESKD. (D) Kidney transplant wait-listing among patients with urinary tract cancer–related ESKD.